Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
AJR Am J Roentgenol. 2012 Apr;198(4):869-77. doi: 10.2214/AJR.11.6794.
The purpose of this study was to review the radiographic and MRI findings of bisphosphonate-related femoral periosteal stress reactions to propose a scoring system for predicting symptoms and fracture risk.
A retrospective study included patients undergoing long-term bisphosphonate therapy who had radiographic evidence of focal femoral periosteal thickening on radiographs and MR images. There were 43 femoral periosteal stress reactions in 33 patients; eight patients underwent MRI. Radiographs and MR images were evaluated for focal cortical thickening (periosteal and endosteal), bone edema, focal cortical abnormalities (radiolucency, striations, cavities), and dreaded black line. The radiographic score (derived with statistical methods) and simple scores (simple radiographic, MRI, and combined scores) were compared with symptoms and fracture outcome.
Logistic regression analysis showed an association between radiographic dreaded black line and symptoms (odds ratio, 68.0). Kaplan-Meier and Cox regression analyses showed radiographic dreaded black line (p < 0.0005; hazard ratio, 27.3) and focal cortical radiolucency (p = 0.011; hazard ratio, 6.8) were independent predictors of fracture. The survival score derived from Cox regression coefficients showed good separation of high- and low-risk groups. Mann-Whitney tests showed an association between MRI and combined scores and symptoms (p = 0.036, p = 0.036). The area under the receiver operating characteristic curve suggested better association with symptoms for MRI and combined scores than for simple radiographic scores (1.00, 1.00, 0.93).
In bisphosphonate-related femoral periosteal stress reactions, radiographic dreaded black line and MRI and combined scores were associated with symptoms, and radiographic survival score was predictive of fracture risk. The relation between MRI and combined scores and fracture was not statistically significant.
本研究旨在回顾双膦酸盐相关性股骨骨膜下应力反应的影像学和 MRI 表现，提出一种预测症状和骨折风险的评分系统。
本回顾性研究纳入了长期接受双膦酸盐治疗且 X 线和 MRI 图像上有局灶性股骨骨膜骨膜增厚表现的患者。33 例患者中有 43 例发生股骨骨膜下应力反应，其中 8 例行 MRI 检查。对 X 线和 MRI 图像进行评估，包括局灶性皮质增厚（骨膜和骨内）、骨水肿、局灶性皮质异常（透亮、条纹、空洞）和可怕的黑线。通过统计方法得出的放射学评分（衍生评分）和简单评分（简单放射学、MRI 和综合评分）与症状和骨折结局进行比较。
Logistic 回归分析显示，影像学上可怕的黑线与症状之间存在关联（优势比，68.0）。Kaplan-Meier 和 Cox 回归分析显示，影像学上可怕的黑线（p < 0.0005；风险比，27.3）和局灶性皮质透亮（p = 0.011；风险比，6.8）是骨折的独立预测因素。Cox 回归系数得出的生存评分显示高风险组和低风险组之间有较好的区分。Mann-Whitney 检验显示 MRI 和综合评分与症状之间存在关联（p = 0.036，p = 0.036）。受试者工作特征曲线下面积表明，MRI 和综合评分与症状的相关性优于简单放射学评分（1.00、1.00、0.93）。
在双膦酸盐相关性股骨骨膜下应力反应中，影像学上可怕的黑线和 MRI 及综合评分与症状相关，放射学生存评分可预测骨折风险。MRI 和综合评分与骨折之间的关系无统计学意义。
